Research in Medicine

Background : The third stage of labor is of utmost importance. Prior investigators have proposed different approaches to shorten this stage. The present study was aimed at determining the efficacy of syntometrine, syntocinon and the physiologic approach in the management of the third stage of labor.

Materials and methods : Ninety parturients enrolled for this clinical trial. They were randomly distributed in one of the 3 groups physiologic, syntometrine, and syntocinon. Along with the anterior shoulder appearance, 10 units of oxytocin, or 5 units of oxytocin plus 0.5mg ergometrin was intramuscularly injected in the syntocinon and syntometrine group, respectively. Then the umbilical cord was clamped and cut immediately and finally the placenta was delivered. On the other hand, patients in the physiologic group were not given oxytocic drugs, and umbilical cord was not cut unless the pulse completely disappeared. The efficacy of these approaches was determined on the duration of the third stage of labor and its complications (bleeding during the first 2 hours, hemoglobin, hematocrit, further requirement of oxytocic drugs). Drugs-related side effects were also determined.

 Results : The mean duration of the third stage of labor was 7.4±2.4, 5.5±2.5, and 5.1±2.4 minutes in the physiologic, syntocinon and syntometrine groups, respectively (p<0.001). The amount of bleeding during the first 2 hours were 230±95.2, 217±113, and 176±83.2 ml in the groups, respectively (p<0.05). Hematocrit was 33.3±4.1, 34.7±4, and 36.4±4% in the groups (p<0.05). Further demand for oxytocic drugs was reported in 16.7% of patients in the physiologic group and 13.3% of patients in the syntocinon group, whereas, there was no demand among patients who receive syntometrine (p<0.05). Mild pain was reported in 16.7, 20 and 43.3% of patients in the physiologic, syntocinon and syntometrine groups, respectively (p<0.05).

 Conclusion : In order to manage the third stage of labor, syntometrine is better than syntocinon and syntocinon is better than the physiologic approach.